Swim Instructor Application

Thank you for your interest in teaching lessons with Safe Swim.
In order to have your application processed, you must thoroughly answer all questions on the application. All information will be treated confidentially.

Applications are considered for all independent contractors, and contractors are treated during the agreement, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran or disability status, or any other prohibited basis of discrimination as provided under applicable state and federal law.

Step 1 of 9

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Today's Date*
Date Format: MM slash DD slash YYYY
Are you eligible to work in the United States?*
- Yes
- No
We do not accept applications unless you are eligible to work in the United States.
If you are eligible to work in the United States please correct your answer above.
How did you hear about Safe Swim?*
Name of the person who referred you*
Referred by other:*

Personal Info
Name*
First Last
Email*
Enter Email Confirm Email
Home Phone*
Cell Phone*
Home Address*
Street Address City State ZIP Code

Personal References
Please list two personal references.
Personal Reference*
First Last
Reference Phone*
How do you know this reference?*
Personal Reference*
First Last
Reference Phone*
How do you know this reference?*

Certifications
Select all certifications you currently have:
Education
Which best describes your education?*
Where do you attend school?*
Are you attending summer school?*

Employment History
Employment Reference*
Business Name*
Job Title*
Start Date*
Date Format: MM slash DD slash YYYY
End Date*
Date Format: MM slash DD slash YYYY
Job Duties
May we contact this employer?
Supervisors Name
First Last
Supervisors Phone
Do you have additional Employment History?
Additonal Employment History
Employment Reference
Business Name
Job Title
Start Date
Date Format: MM slash DD slash YYYY
End Date
Date Format: MM slash DD slash YYYY
Job Duties
May we contact this employer?
Supervisors Name
First Last
Supervisors Phone

Experience
Please list your experience as a Swim Instructor:

Availability
As a Independent Contractor, Swim Instructors set their own schedules however in order for us to schedule lessons for our clients we need to know when you are available to teach lessons.
Please list when you are available teach lessons for April, May, June, July, August, September and October:

Resume
Please submit a resume related to your experience as a swim instructor.
If you have a resume, please upload it here:
Accepted file types: pdf, doc, docx.

Independent Contractor Statement
I certify that the facts set forth in this application are true, complete, and correct to the best of my knowledge. I understand that any misrepresentations, falsifications, or omissions on this application can be grounds for immediate denial of my appointment or removal from consideration or, if I have entered into a contract with this company, for immediate termination of that contract. I authorize LEEDAV-CO, Inc. dba Safe Swim to make any necessary inquiries and investigations into my education, references, or employment history. I further authorize, unless otherwise indicated on this application, the release of my information to LEEDAV-CO, Inc. dba Safe Swim by any of the schools, services, or employers listed on this application.

I also hereby release from liability LEEDAV-CO, Inc. dba Safe Swim and its representatives for seeking, gathering, and using such information to make decisions concerning my status as an independent contractor for LEEDAV-CO, Inc. dba Safe Swim and all other persons or organizations for providing such information.

THIS IS NOT AN APPLICATION FOR EMPLOYMENT. I understand and agree that if this application is accepted, my status will be that of an independent contractor and as such, I will be solely responsible for all tax liabilities pertaining to monies received in the course of services I perform.

If I am retained by LEEDAV-CO, Inc. dba Safe Swim as an independent contractor I will:
• Not be entitled to workers compensation benefits.
• Not be entitled to unemployment insurance benefits unless unemployment coverage is provided by me or some other entity.
• Be obligated to pay federal and state income tax on any moneys paid pursuant to the contract relationship.

I represent and warrant that I have read and fully understand the foregoing, and that I seek to become an independent contractor under these conditions.
I agree with the Independent Contractor Statement, enter your full name:*
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Swim Instructor Application

Swim Instructor Application

Step 1 of 9

Personal Info

Personal References

Certifications

Education

Employment History

Additonal Employment History

Experience

Availability

Resume

Independent Contractor Statement

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